Background

The presence of Hiatal Hernia in obese patient is common, its prevelance can reach 20-50%. Significant number of patients are asymptomatic, and Hiatal Hernia are discovered during their workup for other conditions. This video presents the incidental finding of large type 3 Hiatal Hernia during the workup of a patient for Robotic Sleeve Gastrectomy. The patient was asymptomatic with no symptoms of Gastroesophageal Reflux Disease (GERD) and with no evidence of GERD on upper GI study or on Endoscopy. The patient opted to proceed with Sleeve Gastrectomy with concurrent repair of the Hiatal Hernia. The video presents the technique of repair of the Hiatal Hernia and performing the Sleeve Gastrectomy at the same procedure using Robotic surgery. The outcome of the procedure as well as the follow up of the patient for more than six months, showed no evidence of reccurence of the Hiatal Hernia and no evidence of GERD. We concluded that Sleeve Gastrectomy is a feasible procedure to be performed in the setting of large Hiatal Hernia as long as complete reduction of the hernia with repair of the diaphragmatic crurae is performed.